Hell hath no fury like a U.S. town hall meeting on health care.
One of the more contentious issues is the growing public fear, warranted or not, about the introduction of so-called "death panels." These are teams of professionals who purportedly would determine which elderly persons would be considered worthy of receiving health care treatment and which would not.
But as the aging population puts more pressure on scarce resources, debates over who gets essential health care services will become increasingly frequent and contentious. We are not immune from these controversies.
Within the next 20 years, the number of Canadians over the age of 65 will rise to 40 per cent of the population from 20 per cent today. The International Monetary Fund warns in a recent report that the toll of aging on G20 countries will be 10 times greater than that of the current financial crisis.
The typical response to this alarm bell is to look for ways to reform health care in order to ration services more efficiently. Another immediate answer is to shore up the supply of nurses {minus} again, essential, but certainly not sufficient. We are not going to want to house four of every 10 Canadians in hospitals and nursing homes.
The angry U.S. debate speaks clearly to a challenge that we neglect at our peril: the need to pay more attention to solutions that support an aging population in place - at home and in communities. We need to think more creatively about measures that bolster natural forms of care. The "big system" debates on health care devote precious little attention to those who deliver the bulk of care {minus} unpaid caregivers helping family members who need ongoing assistance because of physical, cognitive or mental health conditions.
There are an estimated three million informal caregivers in Canada. The annual economic value of their unpaid work is pegged at more than $5-billion. The challenge is to figure out how to look after the caregivers so that they can cope with the pressing demands of caring for aging parents (and often children at the same time). There are many options, including greater provision of home support services and workplace policies that allow flexibility for elder care.
Another possibility involves support for the development of secondary suites. These are self-contained units, sometimes referred to as "granny flats," which are separate from a principal residence. Secondary suites are an affordable housing option {minus} especially for singles, seniors and people on low or fixed incomes.
But they are also a good solution for many households trying to provide care to older family members. Secondary suites allow caregivers to be close to care receivers while both maintain an independent living space.
Obstacles to the development of secondary suites include municipal zoning requirements that often prohibit this kind of addition. An estimated 220 of 404 municipalities {minus} just over half {minus} permit this arrangement. More local governments need to come onboard.
The second barrier involves cost. Because secondary suites are self-contained units, they must conform to zoning, building and fire code requirements. They must meet health and safety standards regarding natural light, heating and ventilation, thermal and sound insulation and fire protection.
In March, a new program took effect in Victoria that helps homeowners install a secondary suite. The city offered a grant equal to 25 per cent of construction costs for new units, up to a maximum of $5,000. On Sept. 8, the Vancouver expects to pass a bylaw that will enable secondary suites in apartments.
Victoria estimates its $250,000 investment for this purpose could result in up to $14-million worth of safe, affordable housing. The city likely has not assessed the value of enhancing the ability of seniors to live independently and easing pressures on caregivers who struggle to ensure the best possible quality of life for their loved ones. That contribution has no dollars attached; it is priceless.
Perhaps we can use the heat from the firestorm to the south to fuel our own debate on care. Ideally, it will be calmer in tone and broader in scope in order to capture important ideas that are not now part of the health-care mix. It is not immediately obvious, for example, that urban planning holds one of the keys to a pressing societal challenge. Yet affordable housing that enables the close and continuing care of seniors should be top of the list.
Sometimes, the best solutions are the ones found in our own backyards.
Sherri Torjman is vice-president of the Caledon Institute of Social Policy.